Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-23T12:44:24.137Z Has data issue: false hasContentIssue false
  • English
  • Français

Do injection drug users have more adverse events during procedural sedation and analgesia for incision and drainage of cutaneous abscesses?

Published online by Cambridge University Press:  04 March 2015

Frank Xavier Scheuermeyer ,
Gary Andolfatto ,
Lisa Lange ,
Danielle de Jong ,
Hong Qian  and
Eric Grafstein
Frank Xavier Scheuermeyer*
Affiliation:
Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, BC
Gary Andolfatto
Affiliation:
Department of Emergency Medicine, Lions Gate Hospital and the University of British Columbia, North Vancouver, BC
Lisa Lange
Affiliation:
Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, BC
Danielle de Jong
Affiliation:
Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, BC
Hong Qian
Affiliation:
Center for Health Evaluation and Outcome Sources (CHEOS), St Paul's Hospital and the University of British Columbia, Vancouver, BC
Eric Grafstein
Affiliation:
Department of Emergency Medicine, Mount St Joseph's Hospital and the University of British Columbia, Vancouver, BC
*
Department of Emergency Medicine, St Paul's Hospital, 1081 Burrard Street, Vancouver BC; [email protected]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

Injection drug users (IDUs) often undergo procedural sedation and analgesia (PSA) in the emergency department (ED). We compared adverse events (AEs) for IDUs to those for non-IDUs receiving PSA for incision and drainage of cutaneous abscesses.

Methods:

This was a retrospective analysis of a PSA safety audit. IDU status was prospectively documented among consecutive patients undergoing PSA at two urban EDs. Structured data describing comorbidities, vital signs, sedation regimens, and adverse events were collected. Primary outcome was the proportion of patients in each group experiencing an AE, whereas the secondary outcomes included recovery times.

Results:

Of 525 consecutive patients receiving PSA for incision and drainage of an abscess, 244 were deemed IDUs and 281 non-IDUs. IDUs received higher doses of sedatives and analgesics, and 14 experienced AEs (5.7%), whereas 10 non-IDUs had AEs (3.6%), for a risk difference of 2.1% (95% CI -1.8, 6.5). Median recovery times were 18 minutes (interquartile range [IQR] 10-36) for IDUs and 12 minutes (IQR 7-19) for non-IDUs, for a difference of 6 minutes (95% CI 2-9 minutes). Median sedation times were also longer in IDUs, for a difference of 6 minutes (95% CI 5-10 minutes). Of 20 IDU patients and 1 non-IDU patient admitted to hospital, none had experienced an AE related to PSA.

Conclusions:

For ED patients requiring PSA for incision and drainage, IDUs had an AE rate similar to that of non-IDUs but longer sedation and recovery times. In experienced hands, PSA may be as safe in IDUs as in patients who do not use injection drugs.

Keywords

infectious diseasesmarginalized populationspain management
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 15 , Issue 2 , March 2012 , pp. 90 - 100
Copyright
Copyright © Canadian Association of Emergency Physicians 2013

References

REFERENCES

1.World drug report. Vol 1. Analysis. New York: United Nations Office on Drugs and Crime; 2004.Google Scholar
2.Palepu, A, Tyndall, MW, Leon, H, et al. Hospital utilization and costs in a cohort of injection drug users. CMAJ 2001;165:415–20.Google Scholar
3.Gordon, RJ, Lowy, FD. Bacterial infections in drug users. N Engl J Med 2005;353:1945–54, doi:10.1056/NEJMra042823.CrossRefGoogle ScholarPubMed
4.Kreek, MJ. Cocaine, dopamine, and the endogenous opioid system. J Addict Dis 1996;15:73–96, doi:10.1300/J069v15n04_05.CrossRefGoogle ScholarPubMed
5.Silverman, SM. Opioid induced hyperalgesia: clinical implications for the pain practitioner. Pain Physician 2009;12:679–84.CrossRefGoogle ScholarPubMed
6.Hay, JL, White, JM, Bochner, F, et al. Hyperalgesia in opioidmanaged and opioid-dependent patients. J Pain 2009;10:316–22, doi:10.1016/j.jpain.2008.10.003.CrossRefGoogle ScholarPubMed
7.May, JA, White, HC, Leonard-White, A, et al. The patient recovering from alcohol or drug addiction: special issues for the anesthesiologist. Anesth Analg 2001;92:1601–8, doi:10.1097/00000539-200106000-00050.CrossRefGoogle ScholarPubMed
8.Kuczkowski, KM. Anesthetic implications of drug abuse in pregnancy. J Clin Anesth 2003;15:382–94, doi:10.1016/S0952-8180(03)00056-4.CrossRefGoogle ScholarPubMed
9.Constantino, TG, Parikh, AK, Satz, WA, et al. Ultrasonograph-guided peripheral intravenous access versus traditional approaches in patients with difficult intravenous access. Ann Emerg Med 2005;46:456–61, doi:10.1016/j.annemergmed.2004.12.026.CrossRefGoogle Scholar
10.Mehta, V, Langford, RM. Acute pain management for opioid dependent patients. Anaesthesia 2006;61:269–76, doi:10.1111/j.1365-2044.2005.04503.x.CrossRefGoogle ScholarPubMed
11.Richebe, P, Beaulieu, P. Perioperative pain management in the patient treated with opioids: continuing professional development. Can J Anaesth 2009;56:969–81, doi:10.1007/s12630-009-9202-y.CrossRefGoogle ScholarPubMed
12.Scheuermeyer, FX, Grafstein, E, Stenstrom, R, et al. Thirtyday outcomes of emergency department patients undergoing electrical cardioversion for atrial fibrillation or flutter. Acad Emerg Med 2010;17:408–15, doi:10.1111/j.1553-2712.2010.00697.x.CrossRefGoogle Scholar
13.Green, SM, Krauss, B. Procedural sedation terminology: moving beyond “conscious sedation.” Ann Emerg Med 2002; 39:433–5, doi:10.1067/mem.2002.122770.CrossRefGoogle ScholarPubMed
14.Palepu, A, Tyndall, MW, Leon, H, et al. Hospital utilization and costs in a cohort of injection drug users. CMAJ 2001; 165:415–20.Google Scholar
15.Wood, E, Tyndall, MW, Spittal, PM, et al. Unsafe injection practices in a cohort of injection drug users in Vancouver: could safer injecting rooms help? CMAJ 2001;165:405–10.Google Scholar
16.Kerr, T, Stoltz, J-A, Tyndall, M, et al. Impact of a medically supervised safer injection facility on community drug use patterns: a before and after study. BMJ 2006;332:220–2, doi:10.1136/bmj.332.7535.220.CrossRefGoogle ScholarPubMed
17.Mensch, BS, Kandel, DB. Underreporting of substance use in a national longitudinal youth cohort, individual and interviewer effects. Public Opin Q 1988;52:100–24, doi:10.1086/269084.CrossRefGoogle Scholar
18.Aldrete, JA. The post-anesthesia recovery score revisited. J Clin Anesth 1995;7:89–91, doi:10.1016/0952-8180(94)00001-K.CrossRefGoogle ScholarPubMed
19.Worster, A, Bledsoe, RD, Cleve, P, et al. Reassessing the methods of medical record review studies. Ann Emerg Med 2005;45:448–51, doi:10.1016/j.annemergmed.2004.11.021.CrossRefGoogle ScholarPubMed
20.Gilbert, EH, Lowenstein, SR, Kozoil-McLain, J, et al. Chart reviews in emergency medicine research: where are the methods? Ann Emerg Med 1996;27:305–8, doi:10.1016/S0196-0644(96)70264-0.CrossRefGoogle Scholar
21.Willman, EV, Andolfatto, G. A prospective evaluation of “ketofol” (ketamine/propofol combination) for procedural sedation and analgesia in the emergency department. Ann Emerg Med 2007;49:23–30, doi:10.1016/j.annemergmed.2006.08.002.CrossRefGoogle ScholarPubMed
22.Andolfatto, G, Willman, EV. A prospective case series of single-syringe ketamine-propofol (ketofol) for emergency department procedural sedation and analgesia in adults. Acad Emerg Med 2011;18:237–45, doi:10.1111/j.1553-2712.2011.01010.x.CrossRefGoogle ScholarPubMed
23.Andolfatto, G, Willman, EV. A prospective case series of pediatric procedural sedation and analgesia in the emergency department using single-syringe ketamine-propofol combination (ketofol). Acad Emerg Med 2010;17:194–201, doi:10.1111/j.1553-2712.2009.00646.x.CrossRefGoogle ScholarPubMed
24.Murphy, LJ. Hypertension and pulmonary edema associated with ketamine administration in a patient with a history of substance abuse. Can J Anaesth 1993;40:160–4, doi:10.1007/BF03011314.CrossRefGoogle Scholar
25.Deitch, K, Miner, J, Chudnofsky, CR, et al. Does end tidal CO2 monitoring during emergency department procedural sedation and analgesia with propofol decrease the incidence of hypoxic events? A randomized, controlled trial. Ann Emerg Med 2010;55:258–64, doi:10.1016/j.annemergmed.2009.07.030.CrossRefGoogle ScholarPubMed
26.Miner, JR, Heegaard, W, Plummer, D. End-tidal carbon dioxide monitoring during procedural sedation. Acad Emerg Med 2002;9:275–80, doi:10.1111/j.1553-2712.2002.tb01318.x.Google ScholarPubMed
27.Burton, JH, Harrah, JD, Germann, CA, et al. Does end-tidal carbon dioxide monitoring detect respiratory events prior to current sedation monitoring practices? Acad Emerg Med 2006;13:500–4, doi:10.1111/j.1553-2712.2006.tb00999.x.Google ScholarPubMed